Fw: new qs )))-answer

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What is your differential diagnosis?

This is a classic question in any exam and a chance for you to shine and real off your ‘surgical sieve’. Common headings should include the following: traumatic, inflammatory, neoplastic, nutritional, endocrine, drugs/dermatology/degenerative, vascular, immunologic/idiopathic, metabolic and congenital. A neck lump can be differentiated into:• trauma – unlikely• inflammatory/infections – bacterial, viral, parasitic• neoplastic – primary (Hodgkin’s, non-Hodgkin’s lymphoma, leukaemia), secondary (carcinoma–oral, salivary gland or nasopharyngeal are the commonest; malignant melanoma, other). Remember tail of the parotid gland may present in a similar location to the picture above so always consider parotid tumours• drug reaction• sarcoidosis• connective tissue disease

The patient undergoes fine needle aspiration cytology and an ultrasound scan. The provisional diagnosis is lymphoma, but as yet unknown whether it is Hodgkin’s or non-Hodgkin’s disease. What would you expect to read on the pathology report?

Hodgkin’s lymphoma is a malignancy of a specific type of lymphoid precursor cell that has not been completely identified. The cell is referred to as the –Sternberg cell. Clinically this is more common in men than women and is more likely in the third decade of life. Nodes become progressively enlarged and maybe firm or rubbery. Non-Hodgkin’s lymphoma is characterised by diffuse or nodular sheets of lymphocytes or lymphoblasts without the presence of the –Sternberg cell. They carry a worse prognosis that Hodgkin’s and can be classified in a similar manner to Hodgkin’s. It is important to know the subtype as this is important regarding prognosis.

If this patient had a diagnosis of AIDS, what type of lymphoma may be high on the differential diagnosis list other than non-Hodgkin’s lymphoma?

Burkitt’s lymphoma: this tends to arise on the palate and gingiva. Clinically it may appear as a soft tissue nodular mass, and may resemble Kaposi’s sarcoma as many are haemorrhagic

What is the likely treatment for your answer in 3?

Chemotherapy and radiotherapy. Multi-drug chemotherapy has dramatic effects on Burkitt’s lymphoma, although the 5-year survival rate is less than 30% and commonly new lesions occur over time.

SincerelyLyudmylaHuhley

From: Lyudmyla Huhley <huhley2006@...>Subject: new qs ))) Date: Wednesday, 14 July, 2010, 19:09

Please have a look attached photo.Alternatively,you can find this photo 23078 in photo area OREexam cases.

What is your differential diagnosis?SincerelyLyudmylaHuhley